Thursday, April 12, 2012

Intensive preoperative training at home is feasible for frail older people waiting for total hip arthroplasty (THA) and produces relevant changes in functional health, say authors of an article in Archives of Physical Medicine and Rehabilitation.

This single-blind pilot randomized controlled trial was conducted in patients' homes and a general hospital in The Netherlands. Participants were 30 frail people aged 65 and older. Intervention was a preoperative, home-based program supervised by an experienced physical therapist to train functional activities and walking capacity. The control group received usual care consisting of 1 session of instructions.

Feasibility was determined on the basis of adherence to treatment, patient satisfaction, adverse events, walking distance (measured with a pedometer), and intensity of exercise (evaluated with the Borg scale). Preliminary preoperative and postoperative effectiveness was determined by the Timed Up & Go (TUG) test, 6-minute walk test (6MWT), Chair Rise Time, and self-reported measures of functions, activities, and participation.

Patient satisfaction and adherence to the training were good (median=5 on a 5-point Likert scale) and no serious adverse events occurred. The Borg score during training was 14 (range 13-16). Preoperative clinical relevant differences on the TUG test (2.9s) and significant differences on the 6MWT (41m) were found between groups.

According to the authors, a larger multicenter randomized controlled trial is in progress to investigate the cost effectiveness of preoperative training.